Tomycz Luke, Haider Ali S, Miley Jefferson
Pediatric Neurosurgery, Dell Children's Medical Center of Central Texas.
Texas A&M College of Medicine.
Cureus. 2017 Nov 24;9(11):e1874. doi: 10.7759/cureus.1874.
Cranial dural arteriovenous fistulae (dAVFs) are complex vascular lesions, rarely encountered within the pediatric population. Endovascular embolization has revolutionized the management of these lesions and should be regarded as the first-line treatment for the majority of dAVFs; however, in a subset of particularly complicated lesions, traditional routes of access either do not exist or have been eliminated in the course of prior embolization attempts. We describe the case of an 11-year-old boy with a complicated torcular dAVF refractory to multiple attempts at standard endovascular treatment. He was cured after direct surgical puncture of the superior sagittal sinus to obtain vascular access for coil embolization of the venous sac. We review the technical aspects of this particular case while highlighting the anatomic features of those dAVFs that require nontraditional, surgical access for appropriate treatment. We also describe a simple algorithm, which may help in identifying the small subset of dAVF that requires a hybrid open and endovascular approach to effectively access the fistulous point and achieve disconnection.
颅内硬脑膜动静脉瘘（dAVF）是复杂的血管病变，在儿科人群中很少见。血管内栓塞彻底改变了这些病变的治疗方式，应被视为大多数dAVF的一线治疗方法；然而，在一部分特别复杂的病变中，传统的入路要么不存在，要么在先前的栓塞尝试过程中已被排除。我们描述了一名11岁男孩的病例，他患有复杂的窦汇区dAVF，多次标准血管内治疗尝试均无效。在直接手术穿刺上矢状窦以获得血管通路用于静脉囊的弹簧圈栓塞后，他被治愈。我们回顾了这个特殊病例的技术细节，同时强调了那些需要非传统手术入路进行适当治疗的dAVF的解剖特征。我们还描述了一个简单的算法，这可能有助于识别一小部分需要开放手术与血管内治疗相结合的方法来有效到达瘘口并实现瘘口阻断的dAVF。
